Cost-effectiveness of improving access to treatments for acute ischemic stroke in Peru

Abstract

AbstractObjective: In Peru, access to timely, high-quality acute ischemic stroke (AIS) care is severely limited. This study estimated the cost-effectiveness of strategies to improve uptake of treatments for AIS. Methods: We developed a state-transition model of AIS and its sequelae and parameterized the baseline model using insurance system data, GBD estimates, and studies of stroke epidemiology and costs. Interventions were analyzed through their effects on the AIS “cascade of care”: 1) overall access to emergency departments, 2) access to hospitals capable of treating acute stroke, 3) presentation within 3 hours of symptom onset, 4) and appropriate use of thrombolytics. Scenario 1 looked at certifying hospitals to become basic stroke care centers that could provide thrombolytics to persons currently seeking care. Scenario 2 built on scenario 1 by adding an evidence-based mass media campaign to increase care-seeking for acute stroke. Both scenarios incorporated the impact of expanded access to post-stroke care (e.g., rehabilitation and secondary prevention) following on expanded access to treatment. We took a 20-year time horizon and used a 3% discount rate. Results: Scenario 1 would improve timely access to thrombolytics from 2.3% of AIS to 5.7%; it would reduce stroke mortality by 0.47% and disability by 1.5%, averting 5 deaths among the current cohort of 55-year-old Peruvians (approximately 290,000 individuals). The scenario would cost an additional $1270 per disability-adjusted life-year (DALY) averted. Scenario 2 would improve timely access to thrombolytics from 2.3% to 11.8%; would reduce stroke mortality by 4.2% and disability by 3.8%, averting 46 deaths in the same cohort. The scenario would cost an additional $2,672 per DALY averted. Cost-effectiveness ratios for both scenarios are below Peru’s 2023 GDP per capita ($7900), so they are likely to be cost-effective. Conclusion: Enhanced investment in acute ischemic stroke care is cost-effective and can reduce stroke-related mortality in Peru.